Iom PL Personal History Form
Iom PL Personal History Form
Iom PL Personal History Form
3. A) Present Residence (Specify City, Province or State, Country) B) Since (date) Until (anticipated date) C) Telephone No.
E) Passport or Identity Card No. Date of Issue/Date of Expiry Place of Issue (in full)
Male |__| Female |__| Single |___| Married |__| Widow(er) |__| Divorced |__ Separated |__|
7. Type of engagement preference 8. For what kind of work do you wish to be considered for?
9. Would you accept short term employment? 10. In the event of your selection, how much notice would you need before appointment?
11. Have you any depedents? Yes |___| No |___| If answer is "Yes" give following information:
12. LANGUAGES
(List mother tongue first)
READ WRITE SPEAK
Language
Excellent Good Poor Excellent Good Poor Excellent Good Poor
Page 1 of 4
13. EDUCATION: Give full details, using the following space in so far as it is appropriate of schools or other formal training or education from age 14 (e.g. high
school, technical school, apprenticeship, university or its equivalent):
15. List all organizations with which you are or have been affiliated. This list is to include all affiliations, whether social, professional, fraternal, etc.
16. List activities in civic, public or international affairs and name any significant publications you have written.
18. Have you any objections to our making inquiries of your present employer? Yes |___| No |___|
Page 2 of 4
19. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged, accounting
fully for your time. List military service and any period of unemployment of more than six months' duration. Use a separate block for each
period and additional sheets if necessary.
Present or most recent occupation Description of duties and responsibilities
Dates Annual emoluments:
From To
(month/year) (month/year) Salary
Allowances
Total
Business or organization (name and address, including city)
Page 3(a) of 4
17. EMPLOYMENT RECORD : Starting with your present occupation, list in reverse order each activity in which you have been engaged, accounting
fully for your time. List military service and any period of unemployment of more than six months' duration. Use
Allowances
Total
Business or organization (name and address, including city)
Page 3(b) of 4
20. References: List three persons not related to you who are familiar with your character and qualifications. They must be current or previous supervisors
only.
Name in full Contact Details: Email Address and Phone no. Position Title, Organization/ Affiliation
21. (a) Have you ever been arrested, indicted or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned or placed
on probation in connection with such a proceeding, or have you ever been arrested or required to deposit bail or collateral for the violation of any law or
regulation, civil or military (excluding traffic violations)? (Appointment is subject to security clearance requirements.)
24. State any other relevant facts. Include information regarding any residence or prolonged travel abroad, give dates, areas, purpose, etc. State any
significant experience which you believe will serve in the evaluation of your record.
25. State any disabilities which might limit the performance of your work.
(Appointment is subject to compliance with medical requirements.)
Having answered every question above, I, the undersigned, declare that the information contained in this form is, to the best of my knowledge, true,
complete and accurate, knowing that, if employed, any false declaration or concealment of material facts may result in disciplinary action including
dismissal.
PLEASE NOTE
Applications will not, as a general rule, be valid or retained by the Organization for more than one year from date of receipt. While you may rest assured that
your candidature will be carefully examined, receipt of this form will not be acknowledged, and any further correspondence will be initiated by the
Organization.
Page 4 of 4